type of surgery: planned surgery: surgical...
TRANSCRIPT
LION TV2 – 02/57
TYPE OF SURGERY: Cochlear Implant surgery with intraoperative monitoring
PLANNED SURGERY: Nucleus cochlear implantation 422 electrode (Right EAR)
SURGICAL TECHNIQUE The 422 electrode array will be introduced intraoperative EcochG recordings to show hearing preservation during insertion and intracochlear recordings after insertion
CASE 1/1 (09h15 – 10h30)
SURGEONS: William Gibson & Cathy Birman University Medical School Sydney (Australia)
William Gibson. Cochlear Implantation. Right ear
CLINICAL
History: 61 year old male (JI-C) with a congenital hearing loss first diagnosed at age 4-5 years which has gradually deteriorated.
LION TV2 – 03/57
AUDIOMETRY
William Gibson. Cochlear Implantation. Right ear LION TV2 – 04/57
IMAGING:
William Gibson. Cochlear Implantation. Right ear
CT scan: normal aeration. No cochlear abnormality
MRI: normal
LION TV2 – 05/57
TYPE OF SURGERY: Cochlear implant surgery
PLANNED SURGERY: Med El Flex Soft cochlear implantation for partial deafness treatment (RIGHT EAR)
SURGICAL TECHNIQUE 6 steps Skarzynski Surgical Procedure Round window approach
CASE 1/2 (09h15 – 10h30)
SURGEON: Henryk Skarzynski Institute of Hearing, Physiology & Pathology Warsaw (Poland)
LION TV2 – 06/57
Henryk Skarzynski. Cochlear Implantation. Right ear
CT-Scan: Midde and inner ear – anatomy normal
CLINICAL
History: 17 year old boy with history of bilateral progressive sensory - neural hearing loss since early chilchood, HA user since 3rd year of life, since 1 year no HA user due to limited benefit, difficulties in speech understanding,
Otoscopy: otoscopy in both sides- normal
LION TV2 – 07/57
6 STEPS SKARZYNSKI SURGICAL PROCEDURE
STEP 1 – ANTROMASTOIDOTOMY
STEP 2 – POSTERIOR TYMPANOTOMY TO ALLOW VISUALIZATION OF THE ROUND WINDOW NICHE
STEP 3 – PUNCTURE AND INCISION OF THE ROUND WINDOW MEMBRANE
STEP 4 – APPROACH TO THE SCALA TYMPANI DIRECTLY THROUGH THE ROUND WINDOW MEMBRANE (PARTIAL INSERTION OF THE ELECTRODE ARRAY)
STEP 5 – ELECTRODE FIXATION IN THE ROUND WINDOW NICHE WITH FIBRINE GLUE (MEMBRANE MUST BE PARTIALLY
UNCOVERED TO PRESERVE ITS MOBILITY)
STEP 6 – FIXATION OF THE DEVICE IN THE WALL IN TEMPORAL BONE
LION TV2 – 08/57 Henryk Skarzynski. Cochlear Implantation. Right ear
PURE-TONE AUDIOMETRY
LION TV2 – 09/57 Henryk Skarzynski. Cochlear Implantation. Right ear
TYPE OF SURGERY: Cochlear implant surgery
PLANNED SURGERY: Explantation Nucleus 512 CI (LEFT EAR) because of device failure & Re-implantation with Nucleus CI24RE (CA)
SURGICAL TECHNIQUE Retro-auricular approach. Dissection of the defective CI. Adaptation of the implant bed to the new CI. Explantation of the defective CI. Re-implantation with the new CI.
CASE 1/2 (09h15 – 10h30)
SURGEON: Erwin Offeciers. European Institute for ORL St Augustinus Hospital Antwerp (Belgium)
LION TV2 – 10/57
Erwin Offeciers. Cochlear Explantation and Re-Implantation. Left ear
CLINICAL Male child °2003
History: Congenital deafness – connexine 26 / 30 del G Family history: one sibling with congenital bilateral deafness Right ear: CI Nucleus 24 RCA at age 0;8. Excellent result. Mainstream school at age 5 Left ear: CI Nucleus 512 at age 7;5. Excellent result. Both ears full phoneme and speech discrimination. Normal speech and language development. April 2012: device failure Left ear (Nucleus 512)
Otoscopy: Bilateral normal otoscopy
LION TV2 – 11/57
PURE-TONE AUDIOMETRY – ABR – OAE 2003
Erwin Offeciers. Cochlear Explantation and Re-Implantation. Left ear
Bilateral total deafness / No response on ABR / No OAE response
LION TV2 – 12/57
SPEECH AUDIOMETRY - 2003
Unaided (head phones) and aided thresholds (free field) NVA-list (phoneme score): no response
Hearing aid trial: no progress
Erwin Offeciers. Cochlear Explantation and Re-Implantation. Left ear LION TV2 – 13/57
Erwin Offeciers. Cochlear Explantation and Re-Implantation. Left ear LION TV2 – 14/57
SURGEON: Thomas Lenarz Medizinische Hochschule Hannover (Germany)
TYPE OF SURGERY: Cochlear implant surgery
PLANNED SURGERY: Med-El Flex28 Cochlear implantation (LEFT EAR)
CASE 1/2 (10h30 – 11h30)
LION TV2 – 15/57
Thomas Lenarz. Cochlear Implant Surgery. Left ear
CLINICAL
History: Progressive bilateral SNHL on both sides left > right in the high frequencies No previous history of ear surgery
Otoscopy: Normal findings Weber: to the right ear Rinne: right positive
LION TV2 – 16/57
PURE-TONE AUDIOMETRY
Thomas Lenarz. Cochlear Implant Surgery. Left ear LION TV2 – 17/57
MRI-CT-Scan
Thomas Lenarz. Cochlear Implant Surgery. Left ear LION TV2 – 18/57
TYPE OF SURGERY: Cochlear implant surgery
PLANNED SURGERY: Nucleus Cochlear implantation 422 electrode (LEFT EAR)
SURGICAL TECHNIQUE Bony bead using two flap technique, posterior tympanotomy, “free hand” round window insertion
CASE 1/2 (10h30 – 11h30)
SURGEON: Alex Huber University Hospital Zurich (Switzerland)
LION TV2 – 19/57
CLINICAL
History: 70 year old male. Progressive hearing loss for more than 40 years. Uses bilateral hearing aids (Phonak Naida VSP) since 1980. Has now no benefit using his left hearing aid.
Otoscopy: Normal Otoscopy
Alex Huber. Cochlear Implant Surgery. Left ear LION TV2 – 20/57
PURE-TONE AUDIOMETRY
Alex Huber. Cochlear Implant Surgery. Left ear LION TV2 – 21/57
PURE-TONE AUDIOMETRY
Alex Huber. Cochlear Implant Surgery. Left ear LION TV2 – 22/57
MRI-CT-Scan
Alex Huber. Cochlear Implant Surgery. Left ear LION TV2 – 23/57
TYPE OF SURGERY: Neurotology
PLANNED SURGERY: Vestibular neurotomy for Meniere’s disease (RIGHT EAR)
SURGICAL TECHNIQUE Vestibular neurotomy. Retrolabyrinthine approach Advanced cochlear monitoring & cochlear mapping
CASE 1/1 (10h30 – 12h00)
SURGEON: Jacques Magnan Causse Ear Clinic Béziers (France)
LION TV2 – 24/57
CLINICAL
History: 46 year old female. Right sided Meniere’s disease over 19 years getting worse since 1 year despite Medical treatment (steroids, betahistine, diuterique) Currently 1 severe attack of vertigo per month with simultaneous right-sided fluctuating hearing loss and tinnitus despite medical treatment Persistent imbalance
Otoscopy: Normal
MRI: Normal
Jacques Magnan. Vestibular neurotomy. Right ear LION TV2 – 25/57
PURE-TONE AUDIOMETRY
Jacques Magnan. Vestibular neurotomy. Right ear LION TV2 – 26/57
TYPE OF SURGERY: Cochlear implant surgery
PLANNED SURGERY: Nucleus Straight Array cochlear implantation (RIGHT EAR)
SURGICAL TECHNIQUE Lateral Labyrinthotomy Technique
CASE 1/1 (11h30 – 12h45)
SURGEON: Caglar Batman Marmara Medical University Istanbul (Turkey)
LION TV2 – 27/57
Caglar Batman. Cochlear Implantation. Right ear
CLINICAL
History: 2 year old female child, born in 40th week of pregnancy Her mother and father are cousins. Newborn hearing screening(OAE) was said to be positive bilaterally at 1 month At 11th months SNHL was diagnosed. She was referred to our clinic 3.5 months ago and has been using hearing aids since 13 months.
Clinical examination: Oto-rhino-laryngological examination was normal.
LION TV2 – 28/57
Caglar Batman. Cochlear Implantation. Right ear
CT-Scan
LION TV2 – 29/57
Caglar Batman. Cochlear Implantation. Right ear
MRI
LION TV2 – 30/57
Caglar Batman. Cochlear Implantation. Right ear
MRI
LION TV2 – 31/57
Caglar Batman. Cochlear Implantation. Right ear
3D Imaging
Right Ear
LION TV2 – 32/57
Caglar Batman. Cochlear Implantation. Right ear
3D Imaging
Right Ear Left Ear
LION TV2 – 33/57
TYPE OF SURGERY: Cochlear implant surgery
PLANNED SURGERY: Advanced Bionics Cochlear implantation (LEFT EAR)
SURGICAL TECHNIQUE Supra meatal approach (SMA)
CASE 1/1 (11h30 – 12h45)
SURGEONS: Rinze Tange, Vedat Topsakal University Medical Center Utrecht (Netherlands)
LION TV2 – 34/57
CLINICAL
History: 68 year old female with progressive SNHL of unknown etiology Personal history of hypertension, GER with B blocker and PPI
Otoscopy: Normal
Rinze Tange, Vedat Topsakal. Cochlear Implant Surgery. Left ear LION TV2 – 35/57
PURE-TONE AUDIOMETRY
SPEECH AUDIOMETRY
LION TV2 – 36/57 Rinze Tange, Vedat Topsakal. Cochlear Implant Surgery. Left ear
CT-Scan
LION TV2 – 37/57 Rinze Tange, Vedat Topsakal. Cochlear Implant Surgery. Left ear
Supra Meatal Approach (SMA) *
* Kronenberg J, Migirov L, Dagan T. Suprameatal Approach: new surgical approach for cochlear implantation, J. Laryngol Otol 2001 Apr. 115(4)283-5
LION TV2 – 38/57 Rinze Tange, Vedat Topsakal. Cochlear Implant Surgery. Left ear
TYPE OF SURGERY: Vestibular schwannoma resection
PLANNED SURGERY: Tumor resection (LEFT EAR)
SURGICAL TECHNIQUE Middle Fossa approach
CASE 1/1 (12h00 – 13h30)
SURGEON: Instituto de Otologia Garcia-Ibanez & Centro Medico Teknon Barcelona (Spain)
LION TV2 – 39/57
Emilio Garcia-Ibanez. Vestibular schwannoma resection. Right ear
CLINICAL
History: 40 year-old male 2 months evolution • Left side Tongue disestesia • Taste distortion • Dizziness • Left side tinnitus • Left side migraine
LION TV2 – 40/57
Emilio Garcia-Ibanez. Vestibular schwannoma resection. Right ear
PURE-TONE AUDIOMETRY
LION TV2 – 41/57
ELECTROPHYSIOLOGY
ENG VIIth nerve: normal
VNG: normal
ABR: right side normal left side retrocochlear response
Emilio Garcia-Ibanez. Vestibular schwannoma resection. Right ear LION TV2 – 42/57
MRI
Emilio Garcia-Ibanez. Vestibular schwannoma resection. Right ear
Left intrameatal 7 mm Vestibular schwannoma
LION TV2 – 43/57
MRI
Emilio Garcia-Ibanez. Vestibular schwannoma resection. Right ear LION TV2 – 44/57
MRI
Emilio Garcia-Ibanez. Vestibular schwannoma resection. Right ear LION TV2 – 45/57
SURGEON: Witold Szyfter Poznan University of Medical Sciences Poznan (Poland)
TYPE OF SURGERY: Cochlear implant surgery
PLANNED SURGERY: Hybrid Nucleus Cochlear implantation (RIGHT EAR)
SURGICAL TECHNIQUE Posterior tympanotomy approach and round window insertion of the hybrid electrode
CASE 2/2 (12h45 – 14h00)
LION TV2 – 46/57
Witold Szyfter. Cochlear Implant Surgery. Right ear
CLINICAL
History: 52 year old female with bilateral, progressive hearing loss in medium and high frequencies. Bilateral hearig aids last 17 years, more and more difficulties in speech comprehension
Otoscopy: Tympanic membranes, bilateraly pearly grey with normal light reflex
LION TV2 – 47/57
PURE-TONE AUDIOMETRY
Witold Szyfter. Cochlear Implant Surgery. Right ear LION TV2 – 48/57
CT-Scan
Witold Szyfter. Cochlear Implant Surgery. Right ear LION TV2 – 49/57
SURGEON: Nuri Ozgirgin Bayindir Hospital Sogutozu Ankara (Turkey)
TYPE OF SURGERY: Cochlear Implant Surgery
PLANNED SURGERY: Nucleus Cochlear Implantation (LEFT EAR)
SURGICAL TECHNIQUE Posterosuperior small incision, standard nastoidectomy with tympanotomy posterior, drilling the RW nich to expose the membrane, subperioteal pocket to host the implant body, RW insertion, obliterating with connective tissue
CASE 1/2 (13h45 – 14h45)
LION TV2 – 50/57
Nuri Ozgirgin. Cochlear Implant Surgery. Left ear
CLINICAL
History: 2 year-old; prelingual deafness
Otoscopy: Normal otoscopic findings
LION TV2 – 51/57
Nuri Ozgirgin. Cochlear Implant Surgery. Left ear
HEARING THRESHOLD WITH ERA
LION TV2 – 52/57
IMAGING
Nuri Ozgirgin. Cochlear Implant Surgery. Left ear LION TV2 – 53/57
TYPE OF SURGERY: Mastoid Meningocele + Atical Retraction Pocket
PLANNED SURGERY: Middle Fossa plus Trans mastoid approach (RIGHT EAR)
SURGICAL TECHNIQUE Customized Middle Fossa Approach + + Revision of canal wall up technique
CASE 2/2 (14h00 – 15h30)
SURGEON: Oswaldo Laercio Cruz Hospital Sirio-Libanès Sao Paulo (Brazil)
LION TV2 – 54/57
Oswaldo Laercio Cruz. Mastoid meningocèle. Right ear
CLINICAL
History: MSZ, fem., 53 years old. Right ear presents recurrent infection since adolescence. In 2007 the diagnosis of cholesteatoma was made and she underwent surgery in another service. After 2 years without symptoms she started to fill some secretion and discomfort
Otoscopy: The external auditory canal presents dehiscence of its superior and posterior wall. It is possible to visualize the tympanic membrane with postero-superior retraction
LION TV2 – 55/57
PURE-TONE AUDIOMETRY
LION TV2 – 56/57 Oswaldo Laercio Cruz. Mastoid meningocèle. Right ear
CT-Scan & MRI
LION TV2 – 57/57 Oswaldo Laercio Cruz. Mastoid meningocèle. Right ear